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Copays

In most situations, members must share in the cost of the service provided.

This is a Copayment (or copay), or a set amount members pay when they receive a service.

Please refer to your Member Handbook for complete information about copays.

You can find your copays on your member ID card.

Paying Copays and other Payments

  • You must make copays directly to providers at the time of service.
  • If you do not pay your copay, the provider and/or North Carolina Medicaid may use legal action to collect payment from you.
  • You may be responsible for paying for non-covered services if you sign a release agreeing to pay before services are received. Note, the cost of non-covered services is likely to be more than a copay for a covered service.

Exemptions

These types of members are always exempt from copays:

  • Native American
  • Pregnant women
  • Members receiving hospice care

Other Client Participation

The other type of cost sharing is when a member must pay a portion of their monthly expense. This is referred to as patient liability.  

  • These may include members in an institutional setting, or HCBS Waiver enrollees. Please refer to your Member Handbook for more information.